In 2004, the patient presented acutely with a 1-week history of shortness of breath while receiving oral maintenance steroids (prednisolone, 10 mg). Despite immediate escalation of corticosteroid (hydrocortisone, 200 mg IV tid), she became increasingly distressed and had tachypnea with marked stridor. An urgent tracheostomy to secure her airway was required within 24 h of admission. Empirical antituberculous therapy was commenced. On CT scans, concentric soft-tissue thickening around the level of the glottis and subglottis, extending inferiorly to the intrathoracic trachea, was seen (Fig 3
, top, A). As in 1997, lung windows showed a mosaic perfusion pattern, enlarged pulmonary vessels, and no nodules, pleural thickening, or mediastinal adenopathy. At bronchoscopy, the white nodular pattern was again noted. Biopsy specimens revealed nonspecific granulomatous change and were subsequently culture negative for Mycobacteria.